HD 


UC-NRLF 


GIFT   OF 


DEPT.  OF  ECONOMICS 


Purchasable.      Within  Natural  Limitations  Any  Community  Can  Determine  Its  Own 
Death   Rate 


A  STUDY  OF 


OUSING   CONDITIONS 


MADE  FOR  THE 


[EW  YORK  STATE  DEPARTMENT  OF  HEALTH 

J^A>U-t-^Ax< 


MADGE  HEADLEY 


HERMANN  M.   BIGGS,  M.D. 
Commissioner 


Issued   by  the 
Division  of  Public  Health   Education 


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A  STUDY  OF  HOUSING  CONDITIONS  MADE  FOR  THE  NEW 
YORK  STATE  DEPARTMENT  OF  HEALTH 

The  State  Department  of  Health  has  received  so  many  unfavorable 
reports  on  living  conditions  among  summer  visitors  of  the  poorer  class, 
coming  from  New  York  City  to  certain  nearby  districts  in  the  State,  that 
it  was  thought  desirable*  to  have  an  investigation  of  the  matter  made 
by  an  expert  on  housing.  The  services  of  Miss  Madge  Headley,  an  inves- 
liii-afor  of  housing  conditions,  therefore,  were  engaged  by  the  Commis- 
sioner of  Health  for  several  weeks  during  the  past  summer,  and  an 
abstruet  of  Miss  Headley's  report  is  herewith  presented. 

It  is  the  hope  of.  the  Commissioner  of  Health  that  those  interested  in 
a  problem  of  vital  importance  to  thousands  of  people  in  the  City  and 
rlic  State  of  New  York  (and  which  unquestionably  exists  in  the  vicinity 
of  other  large  cities- through  out  the  country),  may,  by  further  study  of 
the  subject  and  by  mutual  cooperation,  devise  some  plan  by  which  the 
intolerable  conditions  described  may  be  alleviated.  It  is  desired  that 
this  bo  accomplished  without  depriving  women  and  children  of  the 
inestimable  privilege  of  getting  away  from  a  large  city  during  the 
summer  season. 

The  Commissioner  of  Health  welcomes  any  suggestion  or  advice  on 
the  subject  which  may  form  a  basis  for  the  adoption  of  remedial 
measures. 

Letter  from  Dr.  Berry,  State  Sanitary  Supervisor 

SEPTEMBER  13,  1916 

DK.  HERMANN  M.  BIGGS,  Commissioner.  New  York  State  Department 
of  Health,  Albany,  New  York 

DKAR  DOCTOR. —  The  condition  of  many  summer  boarding  houses  in 
Xe\v  York  State  in  certain  districts  adjacent  to  New  York  City  invites 
the  earnest  attention  of  the  State  health  authorities. 

Starting  modestly  with  a  few  additions  to  the  household  in  each  farm 
house,  during  the  warm  months,  for  the  purpose  of  adding  to  the  family 
income,  it  has  developed  into  a  phase  where  flimsy  structures  are  put 
up  expressly  for  this  purpose,  and  people  herded  into  them,  without 
regard  to  sanitation,  privacy  or  the  ordinary  decencies  of  life.  In  many 
places  the  conditions  existing  in  so  called  summer  resorts,  have  a  dis- 
tinct influence  upon  the  mortality  and  morbidity  records  of  the  State. 

The  New  York  City  Health  Department  has  been  calling  attention  in 
their  weekly  bulletins,  to  the  fact  that  the  annual  vacation  looked  for- 
ward to  for  rest,  change,  renewal  and  upbuilding  of  health,  may  from 

393425 


the  conditions  found  in  many  places  frequented   by  vacationists  result 
instead  in  illness  or  even  death. 

The  problem  presented  to  the  sanitarian,  consists  usually  of  a 
small  town  or  village,  with  a  standing  population  of  500  to  1,000,  depend- 
ing on  privies  and  cesspools  for  excreta  disposal,  Around  absorption  for. 
household  waste,  and  wells  and  springs  for  drinking  water,  suddenly 
having  its  inhabitants  increase  20  or  25  fold,  and  amid  conditions  of 
overcrowding,  bad  sanitation  and  general  filth,  of  having  to  isolate  and 
quarantine  a  case  of  communicable  disease  in  a  house  where  even  the 
halls,  front  porch  and  floor  of  dining-room  are  utilized  for  sleeping 
quarters. 

The  care  of  a  case  of  communicable  disease  in  a  crowded  boarding 
house,  has,  for  a  long  time,  been  a  serious  proposition  for  the  local  health 
officer  and  the  State  officials,  removal  to  a  hospital  being  usually  out  of 
the  question  for  the  reason  that  there  is  none  available.  The  ultimate 
outcome  is  one  of  the  following: 

(a)  The  case  is  sent  home  or  dies,  bedroom  is  fumigated.     Busi- 

ness continues  as  usual,  fresh  arrivals  taking  the  place  of 
those  who  decamped  at  the  first  alarm  to  spread  around 
other  places  in  the  district. 

(b)  The  case  is   quarantined   in    a    room    or   outbuild  ing   mi    the 

premises,  and  the  owner  of  the  boarding  house  suffers  con- 
siderable financial  loss  from  the  collapse  of  his  busine— 
for  that  season.  Contacts  are  controlled  more  or  less 
efficiently. 

Attempts  to  establish  isolation  hospitals  in  each  district  have  generally 
been  discouraged  by  the  supervisors,  who  insist  that  it  is  a  local  prob- 
lem to  be  met  solely  by  the  lown  or  village  interested.  Proposition-  t«> 
meet  some  of  the  above  conditions  by  a  system  of  hospital  tents,  to  fa 
owned  by  the  State,  and  loaned  to  districts  as  needed,  have  lieen  con- 
sidered and  rejected  on  account  of  lack  of  funds. 

The  situation  could  be  considerably  clarified  by  having  the  Public 
Health  Council  establish  regulations  for  the  proper  control  of  the  sum- 
mer boarding  house,  similar  to  those  now  in  effect  for  labor  camps. 
Such  regulation-  should  embrace  the  following  points: 

1      Permit  required  Tor  any  place  (not  covered  by  hotel  act  )  which 
accommodates   roomer-  or  boarders  to  the  number  <>f  ten  or 
more. 
'2      Such    permit    to   be    issued    on   application    by    the    local    health 

officer. 

Permit  should  Mate  number  of  gue-ts  allowed,  with  provisions 
for  week-end  visit-,  be  valid  for  a  certain  stated  jM-riod,  he 
revocable  for  cau-e.  and  de-iiiiiate  some  person  who  i-  respon- 
sible for  place. 


4:  Before  permit  is  granted,  health  officer  should  visit  premises 
and  score  the  place  on  the  following  points,  a  certain  score 
being  required.  This  would  allow  for  the  'gradual  education 
of  the  people  as  in  dairy  work. 

Privies :    Cleanliness,  accessibility,  removal  <»f  fecal  matter 
Cesspools :  Construction  ;  location 
Kitchens  and  dining-rooms:     Screened  against  die- 
Food  :     Care  and  storage 
Facilities  for  dish  washing 
Open  or  closed  shelves  for  dishes,  etc. 
Location  and  condition  of  stables 
Condition  and  upkeep  of  dairy. 

Provisions  for  isolation  of  communicable  disease,  either  on  premises, 
or  by  use  of  some  nearby  building  in  conjunction  with  other  boarding 
houses,  each  to  maintain  space  according  to  the  number  of  guests  kept. 
This  requirement  would  eventually  lead  to  establishment  of  proper  iso- 
lation hospitals.  Respectfully  submitted, 

C.  W.  BERRY,  M.  D. 

San  i  I  <i  r  i/  Su/HTrixor 

Miss  Headley's  report 

During  the  last  week  of  July  and  the  first  four  weeks  of  August, 
.1916,  week  by  week,  from  ten  to  seventeen  cases  of  poliomyelitis  were 
reported  to  the  State  Department  of  Health  of  Xew  York,  from  the 
counties  of  Sullivan  and  Ulster.  Most  of  them  were  returned  to  Willard 
Parker  Hospital  as  New  York  City  cases.  These  figures  were  so  high, 
as  compared  with  other  similar  rural  sections  of  the  State,  that  the 
Department  commenced  an  analysis  of  what  a  summer  vacation  might 
involve.  Reports  came  in  from  physicians  in  charge  of  the  district  work, 
from  the  nurses,  and  from  the  local  health  officers,  telling  of  excessively 
insanitary  conditions  and  of  room  overcrowding.  One  nurse  wrote: 

"  Rooms  are  engaged  by  guests  and  board  paid  in  advance.  The  land- 
lord then  takes  in  as  many  more  boarders  as  apply,  <>r  as  lie  can  se<rure 
on  meeting  the  trains,  and  assigns  them  to  rooms  already  occupied, 
if  necessary.  Beds  are  put  up  in  halls,  tents,  attics,  living  rooms 
and  stables.  The  bedrooms  are  always  untidy  slops  nut  emptied, 
beds  unmade,  fruit  and  other  food  exposed  to  flies,  soiled  clothing  piled 
high  in  a  corner  of  the  room,  or  under  the  bed.  Mothers  complain  that 
it  is  impossible  to  provide  for  the  baby's  bath,  or  for  laundry.  The 
toilets,  baths,  hoppers  and  sinks  are  invariably  disgusting  to  look  at  from 
overuse.  Water  supply  for  the  flush  i-  never  adequate.  The  water 
supply  and  sewage  disposal  are  matters  that  C8U86  immediate  concern, 
on  account  of  overcrowded  conditions.  The  food  is  prepared  at  the 


hack  door,  chickens  plucked,  fish  cleaned,  and  refuse  thrown  upon  the 
ground  until  the  general  cleaning  up  takes  place.  Flies  swarm  in  yard- 
and  kitchens." 

From  the  reports  of  the  members  of  the  staff,  it  seemed  evident  ihat 
the  people  who  went  to  the  summer  resorts  of  Sullivan  county,  took 
tin  ir  congested  city  standards  with  them,  and  were  lowering  native 
standards  to  their  own  level.  To  correlate  and  verify  these  reports 
from  the  various  members  of  the  staff,  and  to  make  an  intensive  study 
of  conditions.  Deputy  Commissioner  of  Health  Williams  sent  for  a 
trained  housing  invest igator.  He  gave  instructions  for  a  study  and 
report,  not  from  the  medical  standpoint,  but  on  the  fundamental 


\i  \VER  TYPE  OF  BOARDING  HOUSE.  WINDOWS  AKI.  NAUKOW,  VXD  THERE  ABE  Two 
BEDS  IN  A  BOOM.  MANY  OF  THIS  TYPE  ARE  ADVERTISED  AS  "  MODERN  " 
AND  HAVE  FLUSH  TOILETS  ON  THE  SECOND  AND  THIRD  FLOORS,  GENERALLY 
IN  A  RATIO  OF  ONE  TO  TWENTY  OR  MORE  GUESTS  AND  RARELY  CLEAN 

requisites  of  all  good  housing:  light,  ventilation,  water  supply,  toilets, 
room  overcrowding,  cleanliness,  fire  hazard. 

Because  of  the  limited  time,  the  study  was  confined  to  the  towns  of 
Fallsburg,  Liberty  and  Thompson  in  Sullivan  county,  and  the  town  of 
Wa,warsin^in  Ulster  county,  immediately  adjoining.  While  some  of 
the  local  conditions  are  distinctive,  it  is  believed  that  the  more  serious 
problems  involved  can  be  found  in  many  other  parts  of  New  York  State, 
where  there  are  summer  resorts,  and  that  the  question  of  control  is 
not  purely  a  local  one. 

This  study  deals  strictly  with  small  village  and  farm  conditions. 
The  city  of  Middletown,  and  the  village  of  Liberty,  which  practically 
mark  the  south  and  north  boundaries  of  the  epidemic  of  poliomyelitis 


8 


in  this  section,  have  no  large  village  on  the  railway  line  between  them, 
except  Centerville  Station,  with  less  rhan  one  thousand.  American 
rural  standards,  instead  of  the  congested  standards,  as  reported  by  the 
nurses  and  health  officers,  might  be  expected.  Cases  reported  showed 
that  the  highest  number-  \\rre  coming'  from  the  congested  houses  of  the 
towns  of  Fallsburg,  Liberty  and  Thompson,  in  Sullivan  county,  and 
\Vawarsing  in  Ulster. 

CASES    OF    PoTJO. MYELITIS    IX    SuLLJVA.N     AM)    IVhSTKH    C(H'XTIK> 

(  ACCORDING  TO  WEEKS) 


MUNICIPALITY 

JUNE 

JULY 

AUGUST 

1st 

2d 

3d 

4th 

1st 

2d 

3d 

4th 

1st 

2d 

3d 

4th 

5th 

Sullivan  county: 
Town  of  Callicoon 

1 

1 

3 

i 

5 

1 

6 

3 
1 

'5 

1 
2 

1 

1 
2 

4 

4 

0 

1 
6 

5 

1 
1 

Town  of  Cochecton  
Town  of  Fallsburgh  
Village  of  Centerville  Station.  .  .  . 
Town  of  Forestburg  
Town  of  Fremont  
Town  of  Highland 

Town  of  Liberty 

5 
2 

Village  of  Liberty 

Town  of  Mamakating 

1 

2 
1 
1 

2 

Town  of  Rockland 

1 

2 

1 

2 
1 
1 

Town  of  Thompson 

Village  of  Monticello 

* 

Ulster  county: 
City  of  Kingston  ...                .    . 

1 

1 

1 
1 

1 

"'2 

1 
2 
3 

'i 

4 

10 

Town  of  Esopus  
Town  of  Lloyd  
Town  of  Marbletown  
Village  of  Marlboro  
Town  of  Olive 

3 

1 
I 

1 

i 
i 

1 

1 

Town  of  Rochester. 

1 

4 

3 
1 

i 

1 
1 

1 

Town  of  Rosendale 

1 

i 

2 
2 

1 
1 
1 

Town  of  Saugerties 

i 

1 
'4 

Village  of  Saugerties  . 

Town  of  Shawangunk 

1 

"2 
2 

:i 

Town  of  Ulster  

Town  of  Wawarsing  
Village  of  Ellen  ville  
Town  of  Marlborough 

1 

2 

Types  of  houses 

There  arc  four  types  of  resort  houses  in  the  district  studied:. private 
families  who  take  a  few  boarders  to  supplement  the  family  income; 
houses  formerly  the  homes  of  private  families,  to  which  have  been 
added  extensions  and  additions  for  a  larger  number  of  boarders;  large 
houses  built  especially  for  the  business  of  keeping  boarders:  and 
'"  rooming  houses." 


Rooming  houses 

Because  the  boarding  houses  prefer  adults,  and  because  of  the  expense 
nf  weekly  board  for  a  mother  and  four  or  five  children,  a  specialized 
type  of  "  rooming'  house  "  is  rapidly  increasing  in  numbers.  It  is  the 
worst  tyjx'  investigated,  with  more  chances  for  contagion,  more  insani- 
tary conditions,  and  more  excessive  room  overcrowding. 

Usually  the  rooming  house  is  an  old  farm  house,  in  poor  repair,  with 
from  ten  to  twelve  rooms.  Sometimes  the.  larger  rooms  or  portions  of 
the  halls,  have  been  partitioned  off. 


Ti;\  BEDROOMS,  ONE  FAMILY  IN  EACH,  WITH  COMMON  KITCHEN  AND  DINING 
ROOM;  15  TO  20  ADULTS;  30  TO  40  CHILDREN.  WATER  SUPPLY,  A  SPRING 
WHICH  RECEIVES  SURFACE  DRAINAGE  AND  WASTE  FROM  KITCHEN  SINK; 
ONE  PRIVY  WITH  LOOSELY  BUILT  REMOVAL  DRAWER,  OVERFLOWING  AT  TIME 
OF  INSPECTION 

With  no  water  supply  other  than  the  old  well  or  spring  which  was 
barely  sufficient,  and  not  always  pure,  when  used  only  by  the  original 
farmer's  family;  and  with  no  change  in  the  privy  except  to  dig  a  new 
vault  or  to  move  the  shelter  and  install  moveable  boxes  or  tubs,  renting 
is  begun  to  families.  Each  room  in  the  house  brings  from  $30  to  $50 
for  the  season,  and  is  usually  occupied  from  July  1  to  September  1. 
The  landlord,  provides  beds  and  mattresses  as  agreed,  or  as  many  as 
can  be  fitted  into  the  room,  leaving  scant  free  floor  space.  When  all 
of  the  rooms  have  been  rented,  one  each  to  a  family,  he  pockets  the 
rent,  moves  his  family  to  a  bungalow  or  to  the  barn,  and  assumes  no 


10 


further  responsibility.  Cleanliness  of  rooms,  halls,  common  kitchen 
and  dining-room,  is  "  up  to  the  roomers/7  As  the  landlord  is  genera  11  v 
trying  to  run  the  farm,  to  grow  a  vegetable  garden,  take  care  of  his 
dairy,  and  raise  chickens,  all  of  which  he  sells  at  a  good  profit  to  his 
roomers,  he  and  his  family  are  away  most  of  the  day..  Each  family 
can  lav  hi  a  me  on  another. 


TENEMENT  CONDITIONS  IN  A  VILLAGE.  BEDDING  IN  WINDOWS; 
FOOD  Box  ON  PORCH;  GARBAGE  THROWN  IN  YARD;  2  TO  4 
TENANTS  PER  ROOM 

1  mauine  a  hot  summer  night,  with  the  sixteen  families  of  an  Kast  side 
tenement  house,  swarming  on  the  front  porch  and  refuse-strewn,  sun- 
baked yard  of  an  old  farm  house,  instead  of  spilling  over  the  edge  of  the 
sidewalk  and  the  pavement  of  the  street,  yon  will  know  bow  a  "  rooming 
house  "  in  the  country  looks. 

Imagine  the  whole  family,  mother  and  children  and  father,  with  adult 
kin  who  change  from  time  to  time,  uning  to  bed  in  a  one-room  tenement. 


11 

instead  nt'  spreading  over  the  limited  routines  of  a  four-room  Hat,  you 
will  wonder  what  will  happen  when  some  keen  landlord  discovers  the 
possibilities  of  the  double-decker  bed.  Mother  and  children  stay  all 
summer,  and  father  joins  them  in  his  short  vacation,  or  when  out  of 
work. 

If,  when  daylight  comes,  von  take  another  peep  into  the  one-room 
tenement,  von  will  see  that  in  the  scant  space  left  by  the  beds,  the  food 
is  stored.  On  a  box,  or  small  table,  will  be  uncooked  chicken,  open 
dishes  of  milk,  over-ripe  fruit,  pickled  fish,  rut  bread  —  all  uncovered 
from  dust,  but  covered  with  flies.  The  more  bulky  supplies  are  stored 
under  the  bed,  along  with  the  soiled  clothing.  On  nails  driven  into 
doors  and  walls  hangs  the  family  wardrobe,  taking  scant  room,  for 
changes  are  not  considered  necessary.  In  one  trunk  are  brought  the 
family  clothing,  sheets,  pillows  and  comforters  for  the  beds,  dishes  for 
table  and  cooking,  and  the  baby's  bottles. 

In  most  of  the  rooming  houses,  there  is  a  common  kitchen,  with  cook 
stove,  sink,  and  open  shelves  for  dishes  and  food  storage.  From  a  dozen 
to  twenty  cook  pots  and  coffee  pots  are  jostled  together  on  every  available 
inch  of  the  stove.  The  dining-room  has  scanty  furnishing  of  table  and 
chairs.  When  a  meal  is  finished,  the  few  dishes  of  each  family  are 
more  or  less  washed  in  turn,  but  as  no  one  is  responsible  for  stove,  floor, 
sink  or  tables,  the  accumulated  grease  and  scraps  of  food  are  left  to  the 
flies.  The  floor  is  often  so  slippery  with  grease  as  to  be  dangerous,  and 
a  protest  from  nurse  or  inspector  gains  only  the  answers,  "  Ft  is  my 
vacation  —  why  should  I  work?"  or  "You  should  have  come  on  a 
Friday  —  then  we  clean." 

In  a  few  rooming  houses  cooking  is  done  oil  oil  stoves  in  the  bed 
rooms,  and  the  beds  used  for  a  table,  adding  to  the  confusion  and  dirt. 

Face  washing,  bathing  and  laundry  are  done  at  the  kitchen  sink, 
or  at  the  spring  or  well  in  the  yard.  Sometimes  a  pool  in  the  brook 
is  used  for  bathing,  but  the  water  is  too  cold  for  efficient  cleansing.  It 
is  possible  that  a  little  more  dirt  does  not  hurt  the  older  children.  The 
serious  feature  is  the  lack  of  means  for  properly  caring  for  the  baby's 
bath  and  diapers.  It  was  interesting  to  note  the  careful  attention  to 
the  rules  for  modifying  milk,  learned  at  the  milk  stations  and  earned 
out  with  difficulty;  but  discouraging  to  see  the  bottles  put  in  a  dirty 
ice  box,  with  not  even  a  bit  of  absorbent  cotton  for  a  cover. 

IVrhaps  these  families  are  "no  worse  off"  than  in  the  tenement 
houses  of  the  East  side  where  they  live  in  winter,  but  in  many  \va\> 
they  are  no  better  off.  Much  of  the  hard-earned  money  of  the  busy 
-eason  goes  to  pay  for  the  chance  at  fresh  air  for  mother  and  children, 
paid  in  advance  at  the  beginning  of  the  season.  Some  of  the  more 


12 


careful  mothers  expressed  their  disgust  with  conditions,  and  said  they 
would  never  come  again,  but  felt  that  they  must  stay  and  not  waste  the 
money  already  paid  out. 

The  theory  of  the  rooming  house  is  not  bad.  If  cross  ventilation 
could  be  provided  for  the  bedrooms,  the  overcrowding  is  not  too  serious, 
as  the  family  are  out  of  doors  nearly  all  day.  But  the  scanty  water 
supply,  the  over-used  privy,  the  general  uncleanliness  and  insanitation, 
and  the  dangers  of  contagion,  are  real  menaces.  Housekeeping  is  hard 
for  the  single  farmer's  family  living  alone  in  the  house.  When  the 


FLIMSY  ADDITIONS,  THIN  PARTITIONS  BETWEEN  UPSTAIRS  BEDROOMS.  ONE  WINDOW- 
LESS  ROOM  ON  FIRST  FLOOR.  EXTENSION  IN  REAR  COMBINED  KITCHEN  AND  DINING 
ROOM  FOR  10  FAMILIES.  OUTSIDE  STAIRS  UNSAFE 

same  number  of  rooms,  the  same  water  supply,  and  the  one  privy  must 
serve  ten  to  seventeen  families,  the  difficulties  nre  multiplied  many 
times. 

Boarding  houses 

The  oldest  type  of  boarding  house,  that  of  the  private  family  living 
in  its  own  house  in  a  village  or  on  a  farm,  and  taking  only  a  few 
Ixiarders,  is  rapidly  disappearing.  The  native  families  of  the  district 
investigated,  are  selling  out  and  moving  away.  The  new  owners  buy 
with  the  idea  of  making  a  business  of  keeping  boarders,  with  the  farm 
incidental,  except  as  it  furnishes;  vegetable-,  and  feed  for  the  lmrse> 


and  cows.  The  old  farm  house  soon  has  an  addition  of  three  or  more 
stories,  devoted  to  bedrooms,  or  a  separate  building  is  erected  for  a 
kitchen  and  dining-room,  and  all  of  the  rooms  in  the  old  house  turned 
into  bedrooms.  From  year  to  year,  the  owner  adds  to  the  number  of 
bedrooms,  puts  more  beds  into  the  larger  rooms,  and  gradually  grows. 
He  establishes  the  standard  of  two  beds  and  four  persons  in  each  room. 
In  addition  to  the  common  practice  of  allotting  four  persons  to  a 
room,  privacy  is  still  further  diminished  in  some  of  the  smaller  houses  by 
the  need  of  passing  through  one  bedroom  to  get  to  another,  due  to 


Kr.msy   CONSTRUCTION  OF  ADDITIONS;    BACK  YARD  GARBAGE  STREWN  AND  SAT- 
URATED WITH  SLOPS 

poor  planning  of  additions.  Also  when  larger  rooms  are  divided,  the 
partitions  are  commonly  made  of  thin  boards. 

In  some  of  the  houses,  there  is  no  living  or  sitting  room,  the  only 
common  room  being  the  dining-room.  In  rainy  weather,  boarders 
are  confined  to  their  bedrooms,  as  there  is  no  place  to  go  except  at  meal 
times.  These  conditions  are  especially  prevalent  in  rooming  houses. 

Like  the  newer  houses,  additions  are  constructed  as  cheaply  as 
possible,  adding  not  only  to  the  fire  danger,  but  to  the  hard  work  neces- 
sary to  preserve  even  moderate  cleanliness.  Hough  floors  in  the  kitchen 
are  saturated  with  grease,  cracks  in  bedroom  walls  and  floor  afford 
hiding  places  for  vermin,  plumbing  fixtures  are  so  poorly  installed 


1 1 

that  they  easily  get  out  of  order,  with  a  plumber  many  mile*  away.  The 
"wners  do  not  increase  their  washing  and  bathing  facilities  in  ratio  with 
increased  number  of  boarders,  or  install  a  sufficient  number  of  flush 
toilets.  As  a  rule,  he  does  pipe  water  from  a  spring  into  the  house, 
and  if  necessary  install  a  pump  and  a  storage  tank.  Occasionally  a 
well  is  supplementary,  but  not  the  only  source.  While  the  water  supply 
is  a  little  more  convenient  of  access,  it  is  still  apt  to  he  inadequate  in 
quantity. 

The  third  type  of  boarding  house  is  a  natural  outgrowth  of  the  rapid 
increase  of  the  business  in  the  past  ten  years.     It  is  the  large  house. 


TEXTS  FOR  ACCOMMODATIONS  FOB  ADDITIONAL  l><>.\m>i:i:s;  NO  i  \CHKASK  i\  T«>iu  i 
OR  WASHING  FACILITIES  TO  COMPENSATE  FOR  INCREASED  XUMHKKS 

;!<•<•<  ;mmodating  from  80  to  125  boarders,  specially  built  for  the  purpose. 
The  trade-mark  is  the  attic  story  with  the  dormer  windows.  As  this  is 
the  type  which  is  being  constructed  in  larger  numbers  each  season. 
a  study  should  be  made  for  future  control,  including  the  lire  danger: 
accommodations  for  face  washing,  and  for  bathing;  the  ratio  of  toilets, 
and  provision  for  separation  of  sexes;  water  supply;  disposal  of  wastes 
from  toilets,  from  the  kitchens  and  from  the  stables. 

As  the  buildings  are  intended  only  for  warm  weather  use,  a  certain 
lightness  of  construction  is  probably  permissable.  There  has,  so  far 
as  could  be  ascertained,  been  no  loss  of  life  from  fire.  But  a  number 
of  the  buildings  have  burned  quickly  and  completely,  indicating  the 


•  lander  if  a  tire  should  start  in  the  night  during  the  season.  1'snally 
the  stairs  are  not  continuous,  then-  are  no  fire-escapes,  and  except  in 
the  very  best  houses,  no  tire  extinguishers.  The  house  is  gone  before 
a.  telephone  message  brings  the  nearest  tire  engine. 

Light  and  ventilation 

The  standard  bedroom  for  these  newer  houses  is  about  ten  by  twelve, 
accommodating  two  beds  and  a  dresser,  with  four  persons  to  a  room. 

Disregarding  the  question  of  privacy  with  four  persons  to  a  room, 
the  question  of  ventilation  is  the  important  one.  "Rooms  in  the  corners 


DISTANC  i;  01  TENTS  FKOM  HOUSE;  NO  WASHING  OR  TOILET  FACILITIES  PROVIDED; 
ALL  BOARDERS  USE  TOILET  IN  SECOND  STORY  OF  EXTENSION;  BATHROOM 
BELOW 

get  cross  ventilation,  but  they  are  few  in  number.  Other  rooms  have 
only  one  window,  usually  large,  aiid  ample  as  to  light.  But  as  it  is 
not  usual  to  provide  transoms,  ventilating  flues,  or  any  means  of  making 
a  current  of  air,  the  ventilation  at  very  best,  with  a  good  breeze  blowing, 
is  hardly  adequate  for  four  persons  with  about  a  thousand  cubic  feet 
of  air  to  share.  When  the  air  is  still,  or  when  rainy  weather  compels 
closed  windows,  or  when  one  of  the  four  is  afraid  of  drafts,  the  ventila- 
tion becomes  very  bad.  Because  there  is  plenty  of  fresh  air  outside  ii 
does  not  mean  that  it  gets  inside,  and  part  of  the  purpose  of  the  summer 
vacation  is  defeated  by  sleeping  in  the  poorly  ventilated  and  over- 


16 

crowded  room.  Xor  is  this  a  matter  which  the  boarder  can  improve, 
except  by  leaving  the  bedroom  door  open,  making  an  additional  lack 
in  alreadv  scant  privacy. 

Toilets 

For  these  newer  houses,  the  toilets  are  built  in  when  the  house  is 
constructed,  and  are  less  liable  to  get  out  of  order.  Two  or  four  are 
provided,  usually  two,  supplemented  by  privies.  In  the  boarding  houses 
of  this  type  inspected,  the  ratio  ran  from  one  toilet  to  twenty  persons, 
to  one  for  forty-five.  In  only  two  cases  were  the  toilets  for  men  and 
women  adequately  separated  by  being  placed  on  different  floors.  In  a 
number  of  houses,  compartments  side  by  side  were  marked  "  Gents <r 
and  "  Ladies,"  but  the  signs  were  not  observed. 

Washing  facilities 

in  some  of  the  houses,  one  basin  and  pitcher  were  provided 
for  the  four  occupants  of  a  bedroom.  In  general  practice  twenty  to 
thirty  men  and  women  washed  together  at  the  common  sink,  basin,  or 
hopper,  provided  in  the  halls. 

In  newly  built  houses,  and  in  some  of  the  older  ones,  a  bath  tub  has 
been  installed.  It  is  the  custom  to  charge  25  cents  for  a  bath,  dispro- 
portionately high  for  board  of  $9.00  to  $12.00  per  week.  From  lack 
of  privacy,  and  the  size  of  the  basin,  a  sponge  bath  in  the  bedroom  can 
be  taken  only  with  great  difficulty.  While  there  is  ample  natural  water 
supply  in  the  district,  the  brooks,  ponds  and  springs  are  small  and  cold, 
and  do  not  tempt  to  open  air  bathing. 

Frequently  the  scanty  sanitary  provisions  for  a  house  full  of  boarder- 
are  put  under  additional  pressure  by  the  occupants  of  tent*  or  bunga- 
lows, for  whom  no  separate  provision  is  made. 

In  part  these  omissions  are  due  to  lack  of  education  in  sanitation  :  i  1 1 
part  to  limited  funds  for  building  which  make  every  economy  impera- 
tive ;  and  occasionally  to  low  standards,  or  to  indifference.  For  the  one 
class  education  is  necessary ;  for  another,  definite  standards  which  must 
be  observed  in  spite  of  desire  to  economize ;  and  for  the  last,  compulsion. 

Housekeeping 

In  all  of  these  kinds  of  resorts,  the  rooming  house,  the  built-over  farm 
boarding  house,  and  the  newly  "built  large  houses,  with  rare  exceptions, 
the  housekeeping  is  bad.  The  occasional  landlord  has  good  intentions. 
and  makes  an  effort.  But  because  of  overcrowding,  of  lack  of  con- 
veniences, of  the  difficulties  of  cleanliness  and  of  garbage  disposal  where 
so  much  food  is  prepared,  even  the  best  fail  to  cope  fully  with  their 


17 

problem.  Help  is  difficult  to  get,  the  family  is  overworked  until  it 
becomes  careless,  the  boarders  are  not  overexacting.  Conditions  are 
worst  in  the  poorest  houses,  where  the  lower  rates  are  paid. 

During  the  inspection  only  one  landlady,  a  former  trained  nurse,  was 
found  who  had  the  courage  and  good  sense  to  ask  careless  boarders  who 
would  not  observe  her  rules,  to  move.  At  the  present  expense  of  her 
pocket.book,  but  shrewdly  looking  to  the  future,  she  insisted  on 
cleanliness. 

The  difficulties  of  enforcing  standards  of  sanitation  in  housekeeping 
are  much  more  intricate  and  trying  than  those  of  compelling  or  persuad- 
ing landlords  to  construct  their  houses  with  regard  for  safety,  to  furnish 
an  unpolluted  water  supply,  or  to  provide  sufficient  toilets.  Yet  the 
chances  of  contagion  through  dirty  food,  dishes,  dust,  and  vermin 
are  many,  and  standards  must  be  maintained.  We  have  been  slow  to 
invade  the  right  of  a  woman  to  be  a  poor  housekeeper,  but  since  one 
dirty  kitchen,  or  one  insanitary  house  can  affect  the  whole  community, 
we  must  find  the  way  to  make  her  do  her  share  in  maintaining  health 
standards, 

The  house  inspections,  and  the  orders  given  by  the  nurses  during  the 
poliomyelitis  epidemic,  were  effective,  and  point  the  way  to  one  solution. 
A  nurse  assigned  to  ^acSi  health  officer  during  the  boarding  season,  could 
materially  improve  the  housekeeping.* 

Community  problems 

The.  raj iid  increase  of  population  in  this  district,  without  proper 
i c-r fictions,  lias  resulted  in  lower  standards  of  living,  and  has  adversely 
affected  the  whole  community.  It  has  "  just  growed."  The  consequent 
insanitary  conditions  and  room  overcrowding  can  be  remedied,  and  con- 
trolled by  prompt,  forceful,  and  regular  inspection .  and  enforcement  of 
regulations.  The  experience  gained  will  furnish  a  basis  for  like  enforce- 
ment and  control  in  other  similar  regions. 

The  more  important  problem  is  the  control  of  future  development. 
The  infantile  paralysis  epidemic  has  served  to  rouse  some  communities 
to  needed  reforms,  which  with  the  slower  process  of  education  would 
take  many  years.  While  there  are  a  few  citizens  in  the  inspection  dis- 
trict fully  alive  to  the  need  of  changes,  there  is  no  general  community 
interest  in  the  needed  reforms  of  control  of  construction,  protection  of 
water  supply  against  pollution,  the  installation  of  sufficient  toilets,  and 
the  disposal  of  sewage  and  other  wastes. 

*  The  nurses  employed  during  the  epidemic  were  supplied  by  the  State,  and  one 
nurse  had  to  supervise   several  health   districts. 


18 

Construction  and   fire  danger 

In  addition  to  the  insanitary  conditions  n rising  from  flimsy  construc- 
tion, there  is  the  question  of  five  (hinder.  Two  people  out  of  three  will 
say,  "But  there  never  has  been  nny  loss  of  life"  or  more  cynically, 
"  These  houses  only  hum  up  after  a  had  season."  There  will  be  a  first 
rime. 

There  are  hundreds  of  Hinisy  frame  houses,  with  third  and  fourth 
stories  in  which  the  sleepers  would  he  trapped  by  fire,  or  smothered  by 
smoke  as  they  gropr  bewildered  for  the  narrow  stairs.  Often  the  stair? 


MAIN   Hrii.m.M;:     ON  THK  (Jnoi'Nns  ARE  ALSO  A  COTTAGE  OF  10  ROOMS,  THE  HOME 

OF    OWNKK.    AND    5    ROOMS    OVER   THE    BARN,    MAKING    30    BEDROOMS    AND    FltOM 

•50  TO  To   HKDS.     J)rRix<;  SEASON  THERE  ARK  FROM  *>»  TO  1:M    HOARDERS 

do  not  have  continuous  flights  from  the  top  story  to  the  ground.  They 
have  been  made  to  fit  the  additions  to  the  house,  are  often  steep,  occa- 
sionally without  banisters.  The  halls  are  narrow,  and  not  lighted  b\ 
windows,  or  artificial  lights. 

Water  supply  and  pollution 

The  hill  counties  are  well  supplied  with  springs  and  streams.  There 
U  im  iM-ncral  scarcity  of  easily  available  water  supply.  The  problem 
is  the  prevention  of  pollution  by  individuals  through  ignorance  or  indo 
Irnce.  At  present,  pollution  at  the  various  hoard  hi"  house-  N  so 


and  tlie  danger  so  little  appreciatedj  thai  a  pure  water  supply  is  perhaps 
the  most  pressing  problem.  Closely  allied  is  the  problem  of  cesspools 
;.nd  methods  of  disposal  of  fecal  matter  from  privies. 

In  i>-eneral  the  water  supply  for  all  types  of  houses  comes  I'min 
springs.  A  few  house*  have  wells,  dug  or  driven  ;  a  few  pump  from  a 
brook  <>v  river.  If  the  spring  is  not  enough  higher  than  the  house  in 
insure  a  flow,  a  pump  and  tank  is  installed.  The  water  is  piped  to  the 
kitchen  sink,  to  Hush  toilets,  and  usually  to  a  common  sink  on  each  lloor 
of  the  larger  boarding  houses. 


G  FOR  COOKING  AND  DKIXKI.M;  WATKR;  Two  SOURCES  OF  POLLUTION: 

1  SURFACE  WATER  FROM  YARD  AND  ADJOINING  DRIVEWAY 

2  DRAIN    CARRYING   WASTE   WATER    FROM   LAUNDRY.     TROUGH    (AT   LEFT   OF 

FENCE)  WAS  BUILT  TO  CARRY  OFF  THIS  WASTE.     SMALL  PART  OF  WATER 
GOES  THROUGH  TROUGH;  REST  FLOWS  INTO  HOLLOW  OF  SPRING 

Unless  the  tank  is  kept  full  by  almost  constant  pumping,  or  if  there 
is  a  breakage  of  pipes  or  pump,  a  water  famine  ensues.  At  times  the 
spring  gets  too  low  to  insure  a  clean  supply,  as  the  reservoir  is  usually 
a  small  pool,  and  provision  is  not  made  by  constructing  a  storage  reser- 
voir. In  only  three  of  the  houses  inspected  was  a  cement  reservoir 
found. 

In  a  few  cases  of  leased  houses,  the  owner  lived  in  another  house 
nearby,  and  controlled  the  spring  and  pump.  One  woman  lessee  com- 
plained bitterly  when  the  health  officer  found  her  flush  toilets  full  to  the 
brim,  saying  that  the  owner  would  not  pump.  The  owner  claimed  that 


20 

he  was  perfectly  willing  to  pump,  but  that  the  lessee  would  not  furnish 
gasoline  as  agreed.  Face  to  face  accusations  developed  the  fact  that  the 
lessee  had  not  paid  her  milk  bill,  and  that  the  owner  refused  to  pump 
until  she  did. 

In  another  leased  house,  the  spring  was  small,  the  pump  old  and  worn. 
the  elevation  up  the  hill  and  to  the  tank  considerable,  the  boarder* 
numerous,  the  pipes  and  plumbing  worn  by  overuse  to  constant  break 
age,  the  flush  toilets  filthy.     The  lease  called  for  the  pumping  of  water, 
but  did  not  say  how  much,  and  the  health  officer  had  to  take  a  hand. 

It  would  seem  possible  to  \vork  out  a  ratio  between  number  of  boarders, 
number  of  toilets,  capacity  of  tank,  and  number  of  times  daily  -which 
it  must  be  filled. 

When  there  is  no  tank,  and  the  water  supply  is  pumped  by  hand  from 
a  well,  brought  in  barrels  from  a  spring  in  the  adjoining  field,  or  car- 
ried in  buckets  from  a  spring  in  the  yard,  the  provision  for  an  adequate 
supply  is  still  more  difficult. 

Besides  the  kitchen  sink  (except  in  the  rooming  house),  water  is 
usually  piped  to  one  sink  on  each  bedroom  floor.  One  sink  is  considered 
adequate  for  from  20  to  40  roomers  in  the  main  house,  and  the  over- 
flow of  boarders  in  tents,  bungalows  and  extra  beds.  In  a  few  houses, 
bedrooms  Avere  supplied  with  one  basin  and  pitcher  for  the  four  occu- 
pants. In  no  house  inspected  was  there  a  really  adequate  supply  read- 
ily accessible. 

Pollution 

More  serious  from  a  health  standpoint  than  the  quantity  and  acces- 
sibility of  the  water  supply,  is  its  possible  pollution.  As  the  common 
practice  is  to  take  water  from  a  spring,  there  are  even  a  larger  number  of 
ways  for  the  water  to  become  polluted  than  when  taken  from  a  well. 
Unless  a  reservoir  is  carefully  built,  and  covered  with  a  good  shelter, 
surface  water  can  drain  in,  carrying  various  kinds  of  contaminating 
matter  with  it. 

An  extreme  instance  is  shown  in  the  picture  of  a  boarding  house,  its 
barns  and  outhouses  on  a  hillside  considerably  higher  than  the  spring 
from  which  it  pumps  its  water.  During  the  season,  there  are  about 
one  hundred  boarders,  for  whom  with  the  family  and  help,  four  flush 
toilets  and  two  privies  are  provided.  The  house  yard  is  not  kept  clean  : 
there  is  a  large  amount  of  garbage  and  waste  from  the  cleaning  of 
chickens  which  is  not  given  careful  disposal;  and  the  two  privy  vaults 
at  time  of  inspection  were  overflowing.  The  cow  and  horse  barn  is 
across  the  road,  in  the  same  field  with  the  spring.  There  is  fair  care  of 


manure,  but  the  ground  near  the  barn  is  springy,  and  there  is  consid- 
erable muck  by  the  doors.  In  the  loft  of  the  barn  are  five  bedrooms 
without  toilets. 

The  waste  from  the  flush  toilets,  the  kitchen  sink,  and  the  bath  tub, 
is  carried  in  a  drain  under  the  road  and  down  past  the  barn  to  an 
open  ditch.  Originally  this  ditch  ran  to'  the  foot  of  the  hill  in  a 
straight  line,  somewhat  lessening  the  possibility  of  contamination  of  the 
spring.  But  at  the  time  of  inspection,  the  ditch  was  stopped  up  about 
half  way  down  the  hillside,  a.  pool  of  sewage  had  f owned,  and  the  stream 


RELATION  OF  HOUSE  WITH  GARBAGE  STREWN  YARD  AND  DIRTY  PRIVIES;  AND  OF 
THE  BARN  WITH  FIVE  HORSES  AND  TEN  Cows,  TO  SPRING,  WHICH  is  THE 
WATER  SUPPLY  FOR  95  TO  125  BOARDERS,  FAMILY  AND  HELP 

was  deflected  through  a  depression  in  the  hillside  at  right  angles  to  the 
drain  until  it  again  ran  down  hill  almost  in  a  direct  line  to  the  spring 
at  the  foot  of  the  hill. 

The  spring  flows  to  an  open  pool,  wailed  up  with  loose  stones,  but  with 
no  protection  from  surface  water,  or  from  animals.  Wash  tubs  which 
are  used  both  for  clothes  arid  for  bathing,  according  to  the  statement  of 
the  owner,  are  kept  and  used  at  the  spring. 

This  case  combines  most  of  the  methods  of  pollution,  except 
that  sometimes  overflow  from  a  cesspool  replaces  the  open  drain.  Only  one 
spring  was  inspected  which  seemed  to  be  free  from  sources  of  pollution. 


22 


SHKI.TKR  OVER  Si-urn.  AT  FOOT  OF  HIM..  HOARDS  01-  SHI.I.TKR  KOTTKH  AT  UOTTOM. 
GROUND  AuorM)  SPRING.  DKKP  MTCK.  Sritixd  ONLY  \\ATKH  Si  I'i'i.Y  FOB  10 
KAMI  I.IKS  ix  HOISK.  UKCKIVI  s  Sn:i  AC  i:  I)ISAIX.U;K  FROM  \  \K\}.  Two  PRIMKS 
AXU  KITCIIKX  SINK 


SI«KF\<;    Hoi  si:  o\    |{i(;iiT.  Oxi 


KXTKXSION     \\  ITII     T\VO     I'.l  DI.'OOMS    O\     l.l-.l"! 


It  is  judged  that  ihe  lack  of  protection  is  due  to  ignorance,  and  that 
education  which  includes  practical  advice  for  each  particular  house  is 
the  remedy  needed,  Conditions  vary  so  widely,  and  the  sources  of 
pollution  must  he  so  carefully  considered,  that  no  genera  I  rules  or 
instructions  can  he  made  to  apply. 

The  use  of  water  from  rivers  and  brooks  should  he  forbidden  unle>< 
a  proper  filtration  plant  is  installed.  In  one  house  inspected,  the  supply 
is  pumped  from  a  river  which  is  highly  polluted.  The  owner  claimed 
that  this  water  is  used  only  for  cleaning-  purposes,  and  for  the  flush 
toilets,  and  that  drinking  and  cooking  water  is  carried  from  a  spring 
in  the  yard.  He  was  not  willing  to  estimate  the  number  of  pails  neces- 
sary for  80  to  90  boarders.  Hut  even  if  the  water  from  the  convenient 
faucet  is  used  strictly  for  cleaning,  and  never  for  drinking,  it  is  highly 
probable  that  the  spring  is  polluted  by  drainage  from  the  yard,  driveway 
and  laundry. 

Tn  another  case,  an  owner  had  set  his  privies  across  the  head  of  a 
stream.  A  short  distance  below,  a  group  of  houses  had  damned  the 
stream,  making  a  reservoir  from  which  they  took  their  Avater  supply. 
Only  on  orders  from  the  health  officer  was  the  privy  removed. 

The  same  health  officer  had  an  owner  brought  before  the  Justice  of 
the  Peace  and  fined,  because  wrhen  ordered  to  clean  his  vaults,  he  took 
the  fecal  matter  and  dumped  it  into  a  running  stream. 

Toilets  and  cesspools 

While  water  pollution  is  the  most  serious  general  problem,  there  is 
another  health  question  equally  serious  to  the  individual.  Constipation 
is  rarely  regarded  by  the  layman  as  a  disease,  but  physicians  know  how 
thoroughly  the  body  is  poisoned  when  it  is  disregarded.  Especially  for 
women  and  young  girls,  toilets  should  be  private,  accessible  at  all  times 
of  day  and  night,  and  free  from  nauseating  odors. 

It  is  possible  for  a  private  family  to  care  for  a  privy,  and  by  means 
of  a  removal  box,  to  keep  it  entirely  sanitary.  It  is,  of  course,  rarely 
adequately  accessible  or  private. 

When  a  privy  is  used  by  thirty  or  forty  persons  of  both  sexes,  every 
requisite  is  violated.  Even  with  removal  boxes  frequently  emptied,  it 
is  impossible  to  thoroughly  clean  it. 

Of  twenty-one  houses  inspected,  where  there  was  no  indoor  toilet, 
one  privy  was  used  by  both  sexes  in  the  following  numbers :  under  20 
persons,  three ;  20  to  29,  five ;  30  to  89,  six ;  over  40,  seven.  As  most 
of  these  privies  had  a  vault,  and  as  in  only  one  house  was  any  disin- 
fectant used,  the  filth  and  odor  towards  the  end  of  the  season 


24 


K(jrii'Mi:.\T  OF  PRIVIES.     GENERALLY  ONLY  ONE. 
FLOORS  ROTTEN,  SEATS  FILTHY 


SHELTERS    RICKKTY 


PBIVY  SET  ON   Tor  01    <!i;ot  ND.     Xo    KKMOVAL    l>ox   UK    I'AII.S.     FECAL  MATTER 

OVERFI.OWING   ON   GBOUM>  <M    ISIUi:.   SAIl  I{\II()N    I •<)!{    Koi'H     I-'KKT.       I'SKI)  BY  AT 

LEAST  24  PERSONS  ALL  Si  \s,,\ 


25 

nauseating.     Added  to  this  was  the  lack  of  privacy  in  the  day  time,  and 
inaccessibility  at  night. 

Conditions  at   some  houses,   \\viv  made  still  worse  by  the  emptying 
of  vessels  with  niiiht  soil  either  on  the  ground  ncarhv,  or  carelessly  into 


FOUR  BEDROOMS  WITH  THIN  WALLS,  AND  ACCESS  THROUGH, 
HAVE  BEEN  PARTITIONED  OFF  IN  LOFT  OF  BARN  FOR  USE 
OF  FAMILY  AND  HELP.  PRIVY  WITH  SHAFT  ENDING  AT 
GROUND  (No  VAULT)  CONSTRUCTED  ON  SIDE  OF  BARN. 
ENTRANCE  THROUGH  BEDROOM 

rho  vaults.  The  yards  of  several  houses  furnished  unmistakable  evi- 
dent that  children  and  more  careless  adults  used  any  convenient  place 
outside  of  the  privy. 

Two  houses  were  inspected  with  outdoor  flush  toilets,  which  were  sat- 
isfactory, except  as  to  privacy. 


26 

Indoor  flush  toilets 

Hoard  in  houses  which  can  advertise  "modem  conveniences/'  i<  one 
MI-  |.\vo  dollars  higher.  As  tliis  extra  soon  pay-  for  tin-  installation  of 
plumbing,  there  is  a  tendency  throughout  the  region,  'except  in  the 
rooming  houses,  to  put  in  indoor  Hush  toilets.  However,  usually  -.ne  or 


FLIMSY  CONSTRUCTION  OF  COMPARTMENTS,  AND  POOR  INSTAL- 
LATION OP  PLUMBING.  TOILET  SEAT  BROKEN  OFF  (SECOND 
TOILET  AT  LEFT).  DWARF  DOORS,  INADEQUATE  PRIVACY. 
AS  Two  TOILETS  ARE  USED  BY  BOTH  SEXES  (SEE  NEXT 
PICTURE  FOR  OUTSIDE  CONSTRUCTION) 

i  w<»  arc  fcousidefed  sufficient,  installed  together  in  one  ronm,  with  iwo 
conipjii •tinenis.  They  are  not  adequate  for  the  mimlx  r  of  persons  using, 
or  in  separation  of  sexes.  Privies  are  retained  for  supplementary  use. 
or  for  convenience  when  there  is  a  hreakage  in  the  plumbing,  with  tin4 
inevitable  delay  in  get  ting  a  plumber  to  make  repairs.  As  many  of 


these    toilets    arc    cheaply    installed    in    a    makeshift    way,    breakage   is 
frequent. 

Toilets  are  drained  lo  inadequate  cesspools.  A  hole  from  eight  to  ten 
t'eei  -<piare.  ami  l \vo  to  three  feel  deep  is  duo,  the  loose  earth  or  some 
loosely  piled  stones  adding  to  the  depth.  Boards  are  put  across  the 
top.  and  im>re  earth  loosely  piled  on  them.  There  is  constant  seepage 


WATER  CLOSET  IN  EXTENSION  (Two  COMPARTMENTS)  SUP- 
PORTED BY  POLE.  NOTE  ALSO  CHIMNEY  SUPPORTED  ON 
BRACKET 

or  •  >\ertio\\ ,  as  not  only  the  toilets,  hut  usually  the  kitchen  sinks  and 
dish  tubs  are  drained  to  the  cesspool,  making  a  large  quantity  of  water. 
Tin •-«•  cesspools  are  rarely  cleaned,  but  a  new  one  is  sometimes  dug  to 
take  part  of  the  overflow.  At  a  few  houses  inspected,  the  sewage  was 
found  draining  through  a  short  length  of  tile  to  the  open  field,  or  to  a 
ditch.  Xo  judgment  as  to  possible  water  pollution  is  shown  in  locating 
the  fi— .pool. 


As  an  adequate  cesspool  can  he  constructed  with  -mall  c<>r  for 
material^  and  the  labor  done  by  the  owner,  it  is  probable  that  careful 
instructions  as  to  exact  sixes,  location,  and  most  suitable  method  of  con- 
struction would  bring  alxvut  great  improvement. 

Kitchens  and  back  yards 

Only  in  some  of  the  more  recently  built  large  boarding*  houses  did 
inspection  show  kitchens  which  were  properly  fitted  up.  Good  business 


^i  \\AGE   DISPOSAL   FOR   LARGE   BOARDING    HOUSE.      TILE    COMES    THROV<;H    Two 
WALLS  WITH  ROAD  BET\VI:I:\   AND  is  CARRIED  ON  Top  OF  GROUND  TO  SH  \i 
LOW  HOLE  ^ A  SWAMPY  SPOT.     SEWAGE  LEAKS  THROUGH  AND  SPREADS  OVEK 
FIELD  ABOIT  f>')  FEET  FROM  HOUSE 

practice  indicates  the  value  of  specially  adapted  ranges,  tahles,  dish- 
washing appliances,  closed  cupboards,  and  a  Mnnr  \\hich  can  be  scrubbed. 
The  average  rooming  house  and  smaller  boarding  house  kitchen  i> 
without  any  of  these  things.  As  business  grows,  another  cook  -love  is 
added;  more  open  shelves  are  put  up  for  dishes  and  supplies.  Food 
preparation  is  done  by  the  kitchen  door,  and  the  refuse  thrown  on  the 
ground  until  the  general  clearing  up  after  dinner.  There  is  only  a 
small  tank  for  hot  water,  and  before  the  dinner  dishes  are  all  wa-hed. 
the  water  i-  semi-solid  with  the  food  left  on  them  when  they  are  dumped 


KlTCHF.X    AM)    DlXIXd    I\OOAIS    I  \    OXK-S'I'OKY    KXTKNSION    \\ITII    SKNKKAI.    ADDITIONS. 

LAI  \Din    AND  I'AKT  OF  PREPARATION  OF  VEGETABLES,  DRESSING  OF  CHICKENS 
DONK   ("NDKU  SHI:D.      \OTK  "!,AR<;F   I>AKK  OVFN   STPPOKTHD  ON  POSTS 


KITCHEN  EXTENSION  AND  DISHWASHING  SHEU.  F(K)D  PBEPABATION  AND  HOUSK 
LAUNDRY  DONE  IN  COURT.  (IKOITXD  ODOROUS  WITH  SLOPS  THROWN  FRCM 
KITCHEN  DOOR 


iii.      Onlv  a  rare  housewife  scalds  flu-  dishe-.      They  arc  sen n wiped  or 
-et  11 1 )  to  drain,  and  put  away  on  the  open  shelves. 

"  (leaning  up"  is  done  by  brushing  the  refuse  from  stove  and  table 
to  the  floor,  sweeping  the  piles  out  into  the  yard,  and  perhaps  throwing 
down  a  little  cold  water  011  the  rough  board  floor  to  be  also  swept  into 
Hie  yard.  The  floor  soon  become-  saturated  with  grease,  and  the  yard 
with  slops.  Flies  swarm. 

Disposal  of  wastes 

To  dispose  of  quantities  of  garbage,  ashes  and  rubbish  is  always  ;> 
difficult  problem,  even  in  a  city  where  there  are  regular  collect  ions,  and 


YARD  DIRTY  AND  I'.NKK.MPT.  Two  PRIVIKS  AT  LEFT  OF  I'u  it  1:1:.  YAI  i  i> 
FULL,  SUPPORTS  HOTTED,  YARD  SLOPES  TOWARD  SPUIM.  WHICH  is  \Y\ni; 
SUPPLY  OF  HOUSE 

the  individual  is  relieved  of  a  large  part  of  responsibility.  The  larger 
I  oarding  houses  are  equivalent  to  a  twenty-family  tenement  house,  and 
wastes  are  as  large. 

Two  methods  are  open  to  the  rural  landlord  for  disposing  of  all  but  the 
small  proportion  which  is  fed  to  chickens  or  pigs.  lie  can  bury,  or 
burn.  Either  method,  if  carefully  done,  takes  a  good  deal  of  time  out  of 
a  busy  day,  and  it  is  easy  instead  of  destroying  wastes  daily,  to  allow 
them  to  collect  until  a  large  quantity  is  ready  for  disposal.  This  is 
labor  saving,  but  insanitary.  On  a  farm,  flies  arc  apt  to  be  too  plentiful, 
even  with  extreme  care.  Where  there  are  breeding  places  in  garbage. 


stable  immure,  cesspools  and  privies,  the  increase  is  appalling.  When  a 
large  part  of  the  kitchen  waste  is  animal  matter,  from  the  daily  killing 
and  plucking  of  chickens,  it  becomes  still  more  objectionable. 

Inspection  cannot  be  frequent  enough  to  entirely  control  the  disposal 
of  wastes,  but  it  will  indicate  the  landlords  who  need  careful  super- 
vision, or  education.  A  few  tines  for  nuisances  might  have  a  deterrent 
effect, 

Other  problems  involved 

Incidental  to  the  housing  and  health  problems  of  this  rural  region  of 
rapidly  increasing  summer  population,  is  the  needed  control  of  stores, 
of  milk  supply,  of  the  slaughtering  of  animals  and  chickens,  of  bakeries, 
of  creameries,  and  ice  cream  parlors. 

Inspections  made  by  the  nurses  showed  the  same  inattention  to  sani- 
lary  conditions.  There  is  the  same  need  of  supervision,  and  enforce- 
ment of  regulations  for  cleanliness,  and  prevention  of  sale  of  impure 
or  spoiled  foods. 

An  extreme  instance  which  happened  this  summer  was  that  of  the 
killing  of  an  animal  with  a  tumor  in  its  side,  which  did  not  come  off  with 
i  he  -kin,  and  make  the  meat  kosher.  The  rabbi  cut  out  the  affected  part, 
sold  the  meat  to  a  Gentile  butcher,  who  in  turn  retailed  it  to  his  cus- 
tomers. The  health  officer  learned  of  the  transaction,  brought  the  Gen- 
tile butcher  before  the  Justice,  and  had  him  fined. 

With  a  summer  population  which  overtaxes  all  the  resources  of  the 
district,  and  which  does  not  provide  its  own  supplies  of  meat  or  vege- 
tables, supervision  is  especially  necessary. 

Milk  which  is  sold  at  retail  is  protected  by  many  regulations,  Milk 
which  is  produced  in  a  private  dairy,  and  used  on  the  premises  has  no 
inspection  and  no  regulation,  because  it  is  not  technically  sold  at  retail, 
though  actually  it  is  sold  to  the  boarders  as  part  of  their  board.  Milk 
which  is  sold  to  creameries,  and  made  up  into  butter  or  cheese,  also  is 
not  subject  to  supervision,  except  as  sold  from  dairy  farms  on  wrhich 
certain  communicable  diseases  exist,  although  many  of  the  dangers  of 
infection  are  still  present. 

Hi  the  Jewish  boarding  houses  of  this  district,  it  is  customary  to>  give 
a  "  dairy  meal  "  morning  and  night.  Milking  is  done  twice  a  day,  and 
the  milk  is  used  warm,  which  saves  cooling  and  storage.  Better  care 
in  handling,  and  in  cleansing  of  the  utensils  used,  was  clearly  indicated 
in  the  inspections  made. 

It  was  notable  that  most  of  the  city  mothers  had  l>een  carefully 
instructed  in  the  preparation  of  milk  for  the  bottle  babies,  and  carried 
out  their  instructions,  oven  under  »reat  difficulties.  'But  tliev  had  not 


32 

even  rudimentary  knowledge  of  the  nerd  for  cleanliness  in  the  dairy,  or 
in  liandling  of  the  milk.  Nor  did  they  seem  well  informed  as  to  the 
pos-il.ility  of  contamination  when  the  day's  supply  of  hottles  had  been 
prepared  and  pnt  in  the  iee  box. 

The  children 

While  i  i  limitation,  water  pollution,  poor  sewage  disposal,  lack  of 
i-leanline«  in  kitchens,  face  washing  and  body  bathing  done  under  dif- 
ficulties or  not  at  all,  and  room  overcrowding,  hear  dangers  for  adults, 
they  are  especially  serious  for  young  children  and  bahie-. 

A  baby  should  have  its  daily  bath,  its  quiet  nap,  well  laundered  cloth- 
ing and  diapers.  Teachers  of  fresh  air  classes  note  that  <jnite  as  much 
improvement  comes  to  young  children  from  their  quiet  rest  hour,  a* 
from  feeding  or  out  of  door  life.  While  we  are  educating  our  people 
from  the  congested  city  districts  to  spend  part  of  their  hard  earned 
wages  in  healthful  summer  vacations,  we  must  see  that  they  do  not 
think  that  the  -tandards  of  congestion  are  right  for  the  open  fields,  and 
that  health  is  to  be  gained  simply  by  going  where  there  is  plenty  of 

fresh  air. 

Tuberculosis 

Incidental  to  the  housing  study,  note  Avas  made  of  a  condition  which 
merits  special  investigation  and  consideration. 

The  original  purpose  for  which  a  number  of  families  moved  to  thi.- 
district  was  to  find  good  conditions  for  members  with  tuberculosis.  Some 
of  these  families  are  now  making  a  business  of  taking  boarders  or 
roomers.  Complicated  with  overcrowding,  with  the  common  use  of 
dishes,  drinking  cups  at  wells  and  springs,  and  the  difficulty  of  control 
of  active  cases,  it  would  seem  probable  that  regulations  are  necessary. 

The  problem  is  specially  acute  in  the  boarding  house-  in  the  village 
of  Liberty.  Some  streets  have  become  almost  entirely  devoted  to 
tubercular  patients.  The  health  officer  of  the  village  has  carried  on  a 
lively  campaign  of  education,  and  of  enforcement  of  sanitarv  conditions, 
hut  his  powers  are  limited.  Some  private  houses  have  wall  paper  which 
i.-  seldom  changed;  a  common  toilet,  bathroom,  and  wash  basin  for  all 
sorts  of  oa>es  :  seldom  is  there  adequate  cure  in  dish  washing  »>r  in  com 
mon  use  of  utensils.  Two  to  four  patients  sleep  in  the  >ame  room. 

The  law  providing  for  the  establishment  of  sanatoria  has  proved  ton 
stringent,  rmd  these  uncontrolled  board inu1  houses  are  the  result. 

Summer  vacations 

There  are  still  in  Sullivan  and  I'lster  counties,  thousands  of  open 
acres,  and  hundreds  of  hills,  which  are  admirably  adapted  for  a  sum 


33 

juer  playground,  although  the  increase  in  the  resorts  of  the  region 
during  the  past  ten  years  has  been  astonishing.  These  resorts  have 
»-ro\vn  with  no  State  or  local  building  or  sanitary  regulations  to  control 
construction  or  sanitation.  Kaeh  landlord  suits  his  own  convenience 
and  pocketbook. 

Cities  are  paying  large  health  hills  each  year,  because  of  conditions 
imposed  upon  them  by  similar  lack  of  control  many  years  ago.  Public 
health  is  purchasable-,  but  it  is  hard  to  pay  for  bad  conditions  which 
might  have  been  prevented.  It  is  time  now  to  establish  standards  for 
summer  resorts,  and  to  abolish  insanitary  conditions,  since  no  com- 
munity of  the  State  can  divorce  its  health  from  that  of  other 
communities. 

There  are  many  trite  phrases  which  bring  to  mind  general  pictures. 
When  facts  are  examined,  \ve  are  surprised  at  the  things  taken  for 
granted  which  are  not  there.  "  A  summer  vacation  in  the  country  " 
brings  a  picture  of  fresh  air,  quiet,  rest,  recreation,  healthful  building 
up  of  body  and  mind.  We  expect  some  discomforts,  and  count  them 
part  of  the  experience.  When  we  analyze,  and  these  discomforts  turn 
«>ut  to  lx>  not  minor  annoyances,  but  real  dangers,  the  question  to  be 
answered  is  "How  much  better  are  we  for  a  vacation?"  and  "What 
is  our  summer  vacation  movement  really  doing?  " 

The  various  conditions  herewith  described  would  seem  to  justify  an 
active  interest  in  the  subject  by  the  health  officials  of  New  York  City 
and  the  State  of  New  York  as  well  as  the  local  health  officials  in  the 
districts  involved. 

A   WORD  OF   AI'PHKCIATIOX 

The  study  was  especially  interesting  because  of  the  new  problems  involved.  The  information  was 
gathered  by  the  housing  investigator  in  a  comparatively  short  time,  through  the  unfailing  helpfulness  of 
all  from  whom  the  facts  were  obtained.  Inspections  were  allowe  i  without  protest,  if  sometimes  without 
enthusiasm. 

To  Dr.  Berry  and  Dr.  Clark,  in  charge  of  the  epidemic  work  of  the  district,  constant  reference  was 
made  for  verification  and  for  criticism  of  findings.  The  health  officers  of  the  towns  inspected,  Dr.  Laidlaw, 
Dr.  Cauthers,  Dr.  Payne  and  Dr.  Rapp,  also  Dr.  Payne  of  the  village  of  Liberty,  were  always  ready  with 
ume  taken  from  a  busy  day  for  advice  and  information.  The  reports  on  hou?ing  conditions  made  by  the 
nurses,  Mrs.  Carter,  Miss  Norvell  and  Mfc,s  Hurley  supplemented  and  verified  the  inspections  made. 
From  Mrs.  Laidlaw,  a  native  of  the  district,  reliable  arid  definite  information  was  gained.  Cooperation 
was  never  asked  without  immediate  and  courteous  response,  and  to  it  the  value  of  the  report  is  due. 

MADGE  HE . \rn.K y 


m 


DEPARTMENT 


NO.  DD6 


U.C.BERKELEY  LIBRARIES 


393425 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 


